| National Provider Identifier [NPI]: | 1902801004 |
| Last Name Of The Provider | BROUSSARD |
| First Name Of The Provider | DWANE |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9055 KATY FWY |
| Street Address 2 Of The Provider | STE 200 |
| City Of The Provider | HOUSTON |
| Zip Code Of The Provider | 770241629 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 71 |
| Number Of Services | 1977 |
| Number Of Medicare Beneficiaries | 372 |
| Total Submitted Charge Amount | 142873.63 |
| Total Medicare Allowed Amount | 94760.71 |
| Total Medicare Payment Amount | 69233.74 |
| Total Medicare Standardized Payment Amount | 69384.25 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 182 |
| Number Of Medicare Beneficiaries With Drug Services | 112 |
| Total Drug Submitted ChargeAmount | 5775 |
| Total Drug Medicare AllowedAmount | 3978.21 |
| Total Drug Medicare PaymentAmount | 3874.64 |
| Total Drug Medicare Standardized Payment Amount | 3874.64 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 57 |
| Number Of Medical Services | 1795 |
| Number Of Medicare Beneficiaries With Medical Services | 372 |
| Total Medical Submitted Charge Amount | 137098.63 |
| Total Medical Medicare Allowed Amount | 90782.5 |
| Total Medical Medicare Payment Amount | 65359.1 |
| Total Medical Medicare Standardized Payment Amount | 65509.61 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 16 |
| Number Of Beneficiaries Age 65 to 74 | 221 |
| Number Of Beneficiaries Age 75 to 84 | 91 |
| Number Of Beneficiaries Age Greater 84 | 44 |
| Number Of Female Beneficiaries | 199 |
| Number Of Male Beneficiaries | 173 |
| Number Of Non Hispanic White Beneficiaries | 319 |
| Number Of Black or African American Beneficiaries | 12 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 25 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 361 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 11 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 0.9497 |